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The source you may be referring to is in the
CMS Benefits Manual Chapter 8.
Per #1- the service must be ordered by the
physician
I would read this to mean- that if the
skilling service is nursing rehab you would need a dr. order- even though it can
be scored on the MDS without a specific order
Theresa Lang
Specialized Medical Services,
Inc.
Milwaukee WI
30 - Skilled Nursing Facility Level of Care - General
(Rev. 1, 10-01-03)
A3-3132, SNF-214
Care in a SNF is covered if all of the following four factors are
met:
- • The patient requires skilled nursing services or skilled rehabilitation
services, i.e., services that must be performed by or under the supervision of
professional or technical personnel (see §§30.2 - 30.4); are ordered by
a physician and the services are rendered for a condition for which the
patient received inpatient
hospital services or for a condition that
arose while receiving care in a SNF for a condition for which he received
inpatient hospital services
• The patient requires these skilled services on a daily basis (see
§30.6); and
• As a practical matter, considering economy and efficiency, the daily
skilled services can be provided only on an inpatient basis in a SNF. (See
§30.7.)
• The services must be reasonable and necessary for the treatment of a
patient’s illness or injury, i.e., be consistent with the nature and severity
of the individual’s illness or injury, the individual’s particular medical
needs, and accepted standards of medical practice. The services must also be
reasonable in terms of duration and quantity.
If any one of these four factors is not met, a stay in a SNF, even though it
might include the delivery of some skilled services, is not covered. For
example, payment for a SNF level of care could not be made if a patient needs an
intermittent rather than daily skilled service.
I know the manual says no doctor's order is needed but I was talking to a
coordinator who told me that it just came out (she thought in the Q&As)
that one was needed for Part A. That is the part I am trying to find.
Thanks for the message.
Denise F.
O'Donnell, RN, RAC-C, MN, NHA
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